血管性血友病因子作为临床显著门静脉高压症和严重门静脉高压症的生物标志物：系统评价和荟萃分析。
von Willebrand factor as a biomarker of clinically significant portal hypertension and severe portal hypertension: a systematic review and meta-analysis.
机构信息
CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.
The First School of Clinical Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
出版信息
BMJ Open. 2019 Aug 30;9(8):e025656. doi: 10.1136/bmjopen-2018-025656.
OBJECTIVE
This meta-analysis was performed to investigate the correlation between von Willebrand factor (vWF) antigen and hepatic venous pressure gradient (HVPG) and to evaluate the diagnostic performance of vWF to detect clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH).
DESIGN
Systematic review and meta-analysis.
METHODS
MEDLINE, EMBASE, Web of Science and the Cochrane Library were screened up to 5 April 2018. Studies related to the diagnostic performance of vWF to detect CSPH and/or SPH with HVPG as the reference standard were included. Study quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies scale. Two authors independently used a standardised form to extract data.
OUTCOMES
The primary outcome was the correlation coefficient between vWF and HVPG. The secondary outcome was the diagnostic performance of vWF to detect CSPH or SPH.
RESULTS
A total of six articles involving 994 patients were included in this study. Five of the included articles were used to stratify the results for the correlation coefficient, three for the diagnostic performance of CSPH and two for SPH. The pooled correlation coefficient based on the random effects model was 0.54 (95% CI 0.35 to 0.69), thus suggesting a moderate correlation between vWF and HVPG. The pooled sensitivity, specificity and area under the curve of vWF for CSPH detection were 82% (95% CI 78 to 86), 76% (95% CI 68 to 83) and 0.87 (95% CI 0.80 to 0.94), respectively. Regarding the ability of vWF to detect SPH, the pooled sensitivity and specificity were 86% (95% CI 80 to 90) and 75% (95% CI 66 to 83), respectively. These results supported the satisfactory diagnostic performance of vWF for CSPH and SPH detection.
CONCLUSIONS
vWF, as a novel biomarker, has a moderate correlation with HVPG and shows a satisfactory performance for the diagnosis of CSPH and SPH in patients with cirrhosis.
目的
本荟萃分析旨在探讨血管性血友病因子（vWF）抗原与肝静脉压力梯度（HVPG）之间的相关性，并评估 vWF 检测临床显著门静脉高压（CSPH）和严重门静脉高压（SPH）的诊断性能。
设计
系统评价和荟萃分析。
方法
系统检索 MEDLINE、EMBASE、Web of Science 和 Cochrane 图书馆，检索截至 2018 年 4 月 5 日。纳入 vWF 检测 CSPH 和/或 SPH 的诊断性能与 HVPG 作为参考标准相关的研究。使用诊断准确性研究质量评估量表评估研究质量。两位作者独立使用标准表格提取数据。
结局
主要结局为 vWF 与 HVPG 之间的相关系数。次要结局为 vWF 检测 CSPH 或 SPH 的诊断性能。
结果
共纳入 6 项研究，共计 994 例患者。其中 5 项研究用于分层分析相关系数，3 项研究用于分析 CSPH 的诊断性能，2 项研究用于分析 SPH 的诊断性能。基于随机效应模型的汇总相关系数为 0.54（95%CI 0.35 至 0.69），提示 vWF 与 HVPG 之间存在中度相关性。vWF 检测 CSPH 的汇总敏感度、特异度和曲线下面积分别为 82%（95%CI 78% 至 86%）、76%（95%CI 68% 至 83%）和 0.87（95%CI 0.80 至 0.94）。关于 vWF 检测 SPH 的能力，汇总敏感度和特异度分别为 86%（95%CI 80% 至 90%）和 75%（95%CI 66% 至 83%）。这些结果支持 vWF 对 CSPH 和 SPH 检测具有较好的诊断性能。
结论
vWF 作为一种新型生物标志物，与 HVPG 中度相关，对肝硬化患者 CSPH 和 SPH 的诊断具有较好的性能。
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